Normative Results of Healthy Older Adults on Standard Clinical Vestibular Tests

Abstract

Objective To describe the performance of healthy older adults on common clinical vestibular tests. Patients Fifty community-dwelling older adults aged 70 and older, with mean age of 77.2 ± 6.1 years and range of 70 to 95 years. Intervention(s) Clinical vestibular tests, including spontaneous and head-shaking nystagmus, head impulse test (HIT), bucket test of subjective visual vertical, modified Romberg test (MRT), and Dizziness Handicap Inventory (DHI). Main Outcome Measure(s) Prevalence of abnormal vestibular tests and DHI score. Results We observed a 36% and 44% prevalence of abnormal right and left horizontal HIT, respectively. The bucket test was abnormal in 18% of participants; head-shaking nystagmus was present in 2%, and no participant had spontaneous nystagmus. Approximately 68% of participants had abnormal MRT. Abnormal horizontal HIT and MRT were significantly more prevalent among individuals age 80 years and older compared with those age 70 to 79 years (p < 0.05). Mean DHI score was 5.6 ± 11.2, consistent with no self-reported dizziness handicap. Conclusion This study documents the expected performance of normative older adults on vestibular tests commonly administered in the neurotology clinic. We observed a high prevalence of abnormalities on clinical vestibular testing in healthy older adults, although self-perceived dizziness handicap was low. Further studies using newly available clinical testing methods (e.g., video HIT) may identify finer gradations of vestibular function in older individuals and the levels of vestibular loss associated with functional impairment.

Effects of Device on Video Head Impulse Test (vHIT) Gain

“…This finding is consistent with others. Age related decrements in vHIT VOR gain have been noted in normal control populations in the 8 th or 9 th decade of life [Matino-Soler et al, 2015;Davalos-Bichara and Agrawal, 2014;McGarvie et al, 2015b;Mossman et al, 2015]; however, we did not perform vHIT on subjects greater than 78 years. The lack of age related changes on VOR gain is in contrast to anatomic and physiologic data that show the onset of age effects before the sixth and seventh decades via histological studies documenting physiological reductions in receptor function [Engstrom et al, 1974;Rosenhall, 1973] and the vulnerability of other tests of vestibular function to age [Agrawal et al, 2012;Janky and Shepard, 2009;Taylor et al, 2012].…”

“…Some additional limitations of the current study are that our normal control population did not extend beyond 80 years, which has been documented as a critical age where vHIT abnormalities related to age begin to surface [Matino-Soler et al, 2015;Davalos-Bichara and Agrawal, 2014;McGarvie et al, 2015b]. We also had a small number of individuals with vestibular loss who completed vHIT on all 3 devices.…”

“…While other tests of vestibular function have demonstrated vulnerability to aging, minimal effect of age has been documented with respect to vHIT gain [McGarvie et al, 2015b;Matino-Soler et al, 2015;Davalos-Bichara and Agrawal, 2014;Mossman et al, 2015]. Age has been shown to have little effect on vHIT gain until the 8 th or 9 th decade of life [Davalos-Bichara and Agrawal, 2014;Matino-Soler et al, 2015;McGarvie et al, 2015b;Mossman et al, 2015], but this work has not been replicated and evaluated with all devices.…”

“…Age has been shown to have little effect on vHIT gain until the 8 th or 9 th decade of life [Davalos-Bichara and Agrawal, 2014;Matino-Soler et al, 2015;McGarvie et al, 2015b;Mossman et al, 2015], but this work has not been replicated and evaluated with all devices. Therefore, a second aim of the current study was to evaluate the effect of age on vHIT gain for each vHIT device and gain algorithm.…”

Hacia un nuevo VIII par: Alternativas de baja complejidad

“…Estudios recientes han intentado demostrar el rendimiento diagnóstico de cada una de estas pruebas como elemento único de análisis en el paciente con patología vestibular, ya sea como método de tamizaje o como propuesta para nuevo patrón de oro 21,24,28,[30][31][32][33] . Sin embargo cada test por separado presenta una baja sensibilidad.…”